Two of the leading pro-life organizations in the United States are facing a lawsuit that could threaten their continued operation. California Attorney General Rob Bonta is seeking more than $20 million in penalties against Heartbeat International and RealOptions for providing information and support to women who, after beginning a chemical abortion, decide to attempt to continue their pregnancy through a reversal treatment. Their defenders argue that the case goes beyond these two entities and could set a precedent for all pro-life and faith-based organizations across the country.
More than $20 million in fines
The trial began this week before the Superior Court of Alameda County, nearly three years after the attorney general filed the lawsuit in September 2023.
Bonta is requesting a penalty of $19.86 million against Heartbeat International and another of $640,000 against RealOptions. Both organizations are nonprofit entities that rely on private donations and provide assistance to pregnant women, including material support, counseling, and alternatives to abortion.
The Thomas More Society, which is handling their defense, maintains that fines of this magnitude could force both organizations to close.
Helping women who regret having an abortion
At the center of the litigation is the so-called abortion pill reversal treatment, aimed at women who, after taking the first abortion pill, decide to continue their pregnancy.
Chemical abortion is typically carried out using two medications. The first, mifepristone, blocks the action of progesterone needed to maintain the pregnancy. The second, misoprostol, triggers the contractions that complete the abortion.
Reversal involves administering progesterone before the second medication is taken. Various physicians and associations such as the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), which includes thousands of specialists, maintain that this treatment can allow the pregnancy to continue when applied promptly. Other medical organizations, including the American College of Obstetricians and Gynecologists (ACOG), question its effectiveness and safety.
The lawsuit does not challenge the treatment
One of the most striking aspects of the case, according to the defense, is that the State of California does not claim that chemical abortion reversal is illegal.
The lawsuit targets the way the organizations communicate the existence of this treatment and share testimonies from women who were able to continue their pregnancies. The attorney general considers those testimonies to constitute commercial advertising and, therefore, subject to state laws on false advertising and unfair competition.
The Thomas More Society rejects this interpretation and maintains that Heartbeat International and RealOptions do not engage in commercial activities but instead provide free assistance to pregnant women as part of their pro-life mission inspired by Christian principles.
The defense claims there are no victims
After nearly three years of investigations and discovery, the defense asserts that the State of California has not presented any woman who claims to have been harmed by the actions of the organizations being sued.
“The State has not identified a single woman who claims to have suffered harm, been misled, or even expressed dissatisfaction,” the Thomas More Society maintains, noting that during the proceedings only mothers grateful for the help they received have come forward.
In addition, the attorney general is seeking fines of up to $5,000 for each woman who contacted these organizations to inquire about the reversal treatment—a request the defense considers disproportionate.
A case with consequences for the entire pro-life movement
Beyond the situation of Heartbeat International and RealOptions, the case is being closely watched by pro-life organizations across the United States.
The Thomas More Society believes that a ruling in favor of the prosecution could open the door to new actions against religious entities and nonprofit organizations that provide information about alternatives to abortion or share testimonies related to their charitable work.
According to the defense, the case also raises questions about the application of California law itself, since state regulations recognize protections for those who help a pregnant woman exercise her rights. In the view of the organizations being sued, those rights also include the right to continue a pregnancy when a woman decides not to proceed with a chemical abortion.